HEALTH RESOURCE UTILIZATION WITH CONTINUOUS LENALIDOMIDE TREATMENT (TX) IN ELDERLY PATIENTS WITH NEWLY DIAGNOSED MULTIPLE MYELOMA (NDMM)
(Abstract release date: 05/21/15)
EHA Library. Weisel K. 06/12/15; 103069; S150
Katja Weisel
Contributions
Contributions
Abstract
Abstract: S150
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:30 to 12.06.2015 12:45
Location: Room Stolz 2
Background
MM is an incurable condition associated with high Tx costs. NDMM resource consumption is driven by Tx-related hospitalization, which is highest during periods of uncontrolled disease, such as after diagnosis and during relapses (Arikian SR, ASH 2014 [abstract 2656]; Gaultney JG, J Clin Pharm Ther, 2013). In the pivotal FIRST trial, continuous Tx with lenalidomide plus low-dose dexamethasone (Rd continuous) was compared with fixed-duration Rd (Rd18) or fixed-duration Tx with melphalan, prednisone, and thalidomide (MPT), each for 18 mos, in NDMM pts aged ≥ 65 yrs and ineligible for stem cell transplant (SCT).
Aims
This analysis quantified the rates of hospitalization and medical utilization with Rd continuous based on data collected in the FIRST trial.
Methods
The FIRST trial (N = 1623) is a pivotal, multinational, randomized, open-label phase 3 study. Resource utilization data was collected until patients discontinued study Tx, presented here with a median follow-up of 37 mos (data cutoff = May 24, 2013). The rates of hospitalization and medical utilization for patients treated with Rd continuous (n = 535) were plotted for up to 48 mos to assess whether Rd continuous increased resource utilization over time. Procedures during the Tx period (18 mos) were compared between the 2 fixed-duration Tx arms using negative binomial regression.
Results
Resource utilization among pts treated with Rd continuous declined over time (Figure). The annualized hospitalization rate in the first 3 mos was 3.2 times higher than the average rate for the remaining 45 mos of follow-up (2.02 vs 0.62); medical utilization was 4.2 times higher than average (5.66 vs 1.34). After 4 yrs of Rd continuous Tx, hospitalization and medical utilization rates were estimated to be 83% and 84% lower, respectively, than those observed in the first 3 mos of Tx, reflecting the long-term disease control observed with Rd continuous. The highest hospitalization rates (per pt-yr) were associated with infections (0.20), musculoskeletal disorders (0.06), cardiovascular disorders (0.06), and respiratory and thoracic disorders (0.05). The mean length of stay per admission was 14.08 days (SD, 21.19). The highest medical utilization rates (interventions per pt-yr) were associated with blood transfusions (0.76), general imaging procedures (0.21), respiratory and thoracic imaging procedures (0.20), and therapeutic interventions (0.09). Hospitalization rates were 0.91 (Rd18) and 0.79 (MPT) per pt-yr of follow-up during the Tx period of 18 mos, adjusted rate ratio (RR) of 1.11 (95% CI, 0.92-1.35; P = 0.27). The equivalent rates for medical utilization were 3.00 (Rd18) and 2.85 (MPT) interventions per pt-yr (RR = 0.99 [0.81-1.22]; P = 0.95). A comparison between the 2 fixed-duration arms showed no significant difference in the rates of medical procedures and hospitalizations.
Summary
The rates of resource utilization among pts treated with Rd continuous dropped substantially after the first 3 mos of Tx and gradually declined thereafter. The findings suggest that Tx with Rd continuous does not require a consistently high use of medical and hospital resources. Note that data on resource utilization were collected only while pts were receiving Tx. Additionally, future analysis should include all costs generated by healthcare resource utilization throughout pt Tx, including costs associated with relapses and Tx-free intervals.
Session topic: Quality of life and health economics
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:30 to 12.06.2015 12:45
Location: Room Stolz 2
Background
MM is an incurable condition associated with high Tx costs. NDMM resource consumption is driven by Tx-related hospitalization, which is highest during periods of uncontrolled disease, such as after diagnosis and during relapses (Arikian SR, ASH 2014 [abstract 2656]; Gaultney JG, J Clin Pharm Ther, 2013). In the pivotal FIRST trial, continuous Tx with lenalidomide plus low-dose dexamethasone (Rd continuous) was compared with fixed-duration Rd (Rd18) or fixed-duration Tx with melphalan, prednisone, and thalidomide (MPT), each for 18 mos, in NDMM pts aged ≥ 65 yrs and ineligible for stem cell transplant (SCT).
Aims
This analysis quantified the rates of hospitalization and medical utilization with Rd continuous based on data collected in the FIRST trial.
Methods
The FIRST trial (N = 1623) is a pivotal, multinational, randomized, open-label phase 3 study. Resource utilization data was collected until patients discontinued study Tx, presented here with a median follow-up of 37 mos (data cutoff = May 24, 2013). The rates of hospitalization and medical utilization for patients treated with Rd continuous (n = 535) were plotted for up to 48 mos to assess whether Rd continuous increased resource utilization over time. Procedures during the Tx period (18 mos) were compared between the 2 fixed-duration Tx arms using negative binomial regression.
Results
Resource utilization among pts treated with Rd continuous declined over time (Figure). The annualized hospitalization rate in the first 3 mos was 3.2 times higher than the average rate for the remaining 45 mos of follow-up (2.02 vs 0.62); medical utilization was 4.2 times higher than average (5.66 vs 1.34). After 4 yrs of Rd continuous Tx, hospitalization and medical utilization rates were estimated to be 83% and 84% lower, respectively, than those observed in the first 3 mos of Tx, reflecting the long-term disease control observed with Rd continuous. The highest hospitalization rates (per pt-yr) were associated with infections (0.20), musculoskeletal disorders (0.06), cardiovascular disorders (0.06), and respiratory and thoracic disorders (0.05). The mean length of stay per admission was 14.08 days (SD, 21.19). The highest medical utilization rates (interventions per pt-yr) were associated with blood transfusions (0.76), general imaging procedures (0.21), respiratory and thoracic imaging procedures (0.20), and therapeutic interventions (0.09). Hospitalization rates were 0.91 (Rd18) and 0.79 (MPT) per pt-yr of follow-up during the Tx period of 18 mos, adjusted rate ratio (RR) of 1.11 (95% CI, 0.92-1.35; P = 0.27). The equivalent rates for medical utilization were 3.00 (Rd18) and 2.85 (MPT) interventions per pt-yr (RR = 0.99 [0.81-1.22]; P = 0.95). A comparison between the 2 fixed-duration arms showed no significant difference in the rates of medical procedures and hospitalizations.
Summary
The rates of resource utilization among pts treated with Rd continuous dropped substantially after the first 3 mos of Tx and gradually declined thereafter. The findings suggest that Tx with Rd continuous does not require a consistently high use of medical and hospital resources. Note that data on resource utilization were collected only while pts were receiving Tx. Additionally, future analysis should include all costs generated by healthcare resource utilization throughout pt Tx, including costs associated with relapses and Tx-free intervals.
Session topic: Quality of life and health economics
Abstract: S150
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:30 to 12.06.2015 12:45
Location: Room Stolz 2
Background
MM is an incurable condition associated with high Tx costs. NDMM resource consumption is driven by Tx-related hospitalization, which is highest during periods of uncontrolled disease, such as after diagnosis and during relapses (Arikian SR, ASH 2014 [abstract 2656]; Gaultney JG, J Clin Pharm Ther, 2013). In the pivotal FIRST trial, continuous Tx with lenalidomide plus low-dose dexamethasone (Rd continuous) was compared with fixed-duration Rd (Rd18) or fixed-duration Tx with melphalan, prednisone, and thalidomide (MPT), each for 18 mos, in NDMM pts aged ≥ 65 yrs and ineligible for stem cell transplant (SCT).
Aims
This analysis quantified the rates of hospitalization and medical utilization with Rd continuous based on data collected in the FIRST trial.
Methods
The FIRST trial (N = 1623) is a pivotal, multinational, randomized, open-label phase 3 study. Resource utilization data was collected until patients discontinued study Tx, presented here with a median follow-up of 37 mos (data cutoff = May 24, 2013). The rates of hospitalization and medical utilization for patients treated with Rd continuous (n = 535) were plotted for up to 48 mos to assess whether Rd continuous increased resource utilization over time. Procedures during the Tx period (18 mos) were compared between the 2 fixed-duration Tx arms using negative binomial regression.
Results
Resource utilization among pts treated with Rd continuous declined over time (Figure). The annualized hospitalization rate in the first 3 mos was 3.2 times higher than the average rate for the remaining 45 mos of follow-up (2.02 vs 0.62); medical utilization was 4.2 times higher than average (5.66 vs 1.34). After 4 yrs of Rd continuous Tx, hospitalization and medical utilization rates were estimated to be 83% and 84% lower, respectively, than those observed in the first 3 mos of Tx, reflecting the long-term disease control observed with Rd continuous. The highest hospitalization rates (per pt-yr) were associated with infections (0.20), musculoskeletal disorders (0.06), cardiovascular disorders (0.06), and respiratory and thoracic disorders (0.05). The mean length of stay per admission was 14.08 days (SD, 21.19). The highest medical utilization rates (interventions per pt-yr) were associated with blood transfusions (0.76), general imaging procedures (0.21), respiratory and thoracic imaging procedures (0.20), and therapeutic interventions (0.09). Hospitalization rates were 0.91 (Rd18) and 0.79 (MPT) per pt-yr of follow-up during the Tx period of 18 mos, adjusted rate ratio (RR) of 1.11 (95% CI, 0.92-1.35; P = 0.27). The equivalent rates for medical utilization were 3.00 (Rd18) and 2.85 (MPT) interventions per pt-yr (RR = 0.99 [0.81-1.22]; P = 0.95). A comparison between the 2 fixed-duration arms showed no significant difference in the rates of medical procedures and hospitalizations.
Summary
The rates of resource utilization among pts treated with Rd continuous dropped substantially after the first 3 mos of Tx and gradually declined thereafter. The findings suggest that Tx with Rd continuous does not require a consistently high use of medical and hospital resources. Note that data on resource utilization were collected only while pts were receiving Tx. Additionally, future analysis should include all costs generated by healthcare resource utilization throughout pt Tx, including costs associated with relapses and Tx-free intervals.
Session topic: Quality of life and health economics
Type: Oral Presentation
Presentation during EHA20: From 12.06.2015 12:30 to 12.06.2015 12:45
Location: Room Stolz 2
Background
MM is an incurable condition associated with high Tx costs. NDMM resource consumption is driven by Tx-related hospitalization, which is highest during periods of uncontrolled disease, such as after diagnosis and during relapses (Arikian SR, ASH 2014 [abstract 2656]; Gaultney JG, J Clin Pharm Ther, 2013). In the pivotal FIRST trial, continuous Tx with lenalidomide plus low-dose dexamethasone (Rd continuous) was compared with fixed-duration Rd (Rd18) or fixed-duration Tx with melphalan, prednisone, and thalidomide (MPT), each for 18 mos, in NDMM pts aged ≥ 65 yrs and ineligible for stem cell transplant (SCT).
Aims
This analysis quantified the rates of hospitalization and medical utilization with Rd continuous based on data collected in the FIRST trial.
Methods
The FIRST trial (N = 1623) is a pivotal, multinational, randomized, open-label phase 3 study. Resource utilization data was collected until patients discontinued study Tx, presented here with a median follow-up of 37 mos (data cutoff = May 24, 2013). The rates of hospitalization and medical utilization for patients treated with Rd continuous (n = 535) were plotted for up to 48 mos to assess whether Rd continuous increased resource utilization over time. Procedures during the Tx period (18 mos) were compared between the 2 fixed-duration Tx arms using negative binomial regression.
Results
Resource utilization among pts treated with Rd continuous declined over time (Figure). The annualized hospitalization rate in the first 3 mos was 3.2 times higher than the average rate for the remaining 45 mos of follow-up (2.02 vs 0.62); medical utilization was 4.2 times higher than average (5.66 vs 1.34). After 4 yrs of Rd continuous Tx, hospitalization and medical utilization rates were estimated to be 83% and 84% lower, respectively, than those observed in the first 3 mos of Tx, reflecting the long-term disease control observed with Rd continuous. The highest hospitalization rates (per pt-yr) were associated with infections (0.20), musculoskeletal disorders (0.06), cardiovascular disorders (0.06), and respiratory and thoracic disorders (0.05). The mean length of stay per admission was 14.08 days (SD, 21.19). The highest medical utilization rates (interventions per pt-yr) were associated with blood transfusions (0.76), general imaging procedures (0.21), respiratory and thoracic imaging procedures (0.20), and therapeutic interventions (0.09). Hospitalization rates were 0.91 (Rd18) and 0.79 (MPT) per pt-yr of follow-up during the Tx period of 18 mos, adjusted rate ratio (RR) of 1.11 (95% CI, 0.92-1.35; P = 0.27). The equivalent rates for medical utilization were 3.00 (Rd18) and 2.85 (MPT) interventions per pt-yr (RR = 0.99 [0.81-1.22]; P = 0.95). A comparison between the 2 fixed-duration arms showed no significant difference in the rates of medical procedures and hospitalizations.
Summary
The rates of resource utilization among pts treated with Rd continuous dropped substantially after the first 3 mos of Tx and gradually declined thereafter. The findings suggest that Tx with Rd continuous does not require a consistently high use of medical and hospital resources. Note that data on resource utilization were collected only while pts were receiving Tx. Additionally, future analysis should include all costs generated by healthcare resource utilization throughout pt Tx, including costs associated with relapses and Tx-free intervals.
Session topic: Quality of life and health economics
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